Allergy Studies

alergy

Please answer all of the following questions to determine your eligibility for the allergy study. Once completed, simply press the submit button, and this questionnaire will be sent for review. Please note that only successful candidates will be contacted by our study coordinator.

1.) Are you between the ages of 18 and 65?(* Mandatory Field)

2.) Do you take any medication for your allergy symptoms?(* Mandatory Field)

3.)Are you currently on immunotherapy (allergy shots)?(* Mandatory Field)

4.) Have you ever been on immunotherapy (allergy shots)?(* Mandatory Field)

5.)Do you have history of Asthma?(* Mandatory Field)

As mentioned earlier, your answers and eligibility will be reviewed by our study coordinator, who may contact you with additional questions, or to discuss the details of the study with you.

Please give us your contact information:

Full Name (* Mandatory Field)

Daytime Telephone )(* Mandatory Field

E-mail Address (* Mandatory Field)

By providing and sending this personal information you are allowing ‘Cheema Research Inc’ to contact you to collect information required to screen you for eligibility in a clinical research study, and to collect follow-up data if entered into a clinical research study i.e., strictly for research purpose.

We thank you for your interest in registering with us for our database / clinical studies at Cheema Research Inc!

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